306004073-5-11-2021-22-AS-SSAS-C3F2EX-20210527172037

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306004073
Report Date: 05/11/2021
Date Signed: 05/11/2021 10:41:30 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/23/2021 and conducted by Evaluator James August

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20210323132641

FACILITY NAME:	MISSY'S GUEST HOMES		FACILITY NUMBER:	306004073
ADMINISTRATOR:	RODOLFO G. MENDOZA		FACILITY TYPE:	740
ADDRESS:	9131 HEALEY DRIVE		TELEPHONE:	(714) 530-4421
CITY:	GARDEN GROVE	STATE: CA	ZIP CODE:	92841
CAPACITY:	6	CENSUS: 4	DATE:	05/11/2021
		UNANNOUNCED	TIME BEGAN:	10:21 AM
MET WITH:	Randy Mendoza, Administrator		TIME COMPLETED:	10:41 AM

ALLEGATION(S):

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Facility staff hit resident
Facility staff withheld food from resident

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jim August contacted the facility via telephone to conclude a complaint investigation via telephone due to COVID-19 and precautionary measures. LPA identified himself and discussed the purpose of the call with Administrator Randy Mendoza.
The 10-day initial facility visit was completed on April 1, 2021.

The investigation into the allegations that facility staff hit a resident and withheld food from a resident revealed the following:
On April 1, 2021, LPA August interviewed staff 1 and 2 (S1 and S2). S1 is one of two full time caregivers at the facility. S1 stated that resident 1 (R1) moved to the facility late December 2020. S1 states that R1 was very aggressive with staff and would push staff, scream and yell and at erratically. R1 would refuse to take medications and eat food. S1 stated that staff would document the behaviors and inform the family and doctors of R1’s issues. S1 denies ever hitting or withholding food from R1.
CONTINUED ON LIC9099C DATED MAY 11, 2021...

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: James August
LICENSING EVALUATOR SIGNATURE:	DATE: 05/11/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/11/2021

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 22-AS-20210323132641

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: MISSY'S GUEST HOMES	FACILITY NUMBER: 306004073
	VISIT DATE: 05/11/2021

NARRATIVE

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S2 is one of two full time caregivers at the facility. S2 stated that R1 was very aggressive with staff and would refuse to eat and take medications. S2 would document R1’s actions and that facility staff kept R1’s doctors and family aware of R1’s actions. S2 denied ever hitting or withholding food from R1.

On April 9, 2021 LPA August interviewed witness 1 (W1) who was a family member of R1. W1 stated that S1 was in and out of mental institutions throughout her life and that she has a history of refusing medications, refusing to eat food, belligerence, hitting residents and staff, acting violent and making racist comments to those trying to care for her. W1 stated that they are running out of places where R1 can live.

On April 10, 2021 LPA August interviewed R1. R1 stated that the facility staff were verbally and physically abusive. R1 claims that the staff were abusing her because she refused to perform sexual acts with the staff. R1 stated that she only complained to W1 however other residents in the facility were witnesses to the abuse.

On April 10, 2021 LPA August interviewed residents 2 and 3 (R2 and R3). Both R2 and R3 stated that they have lived at the facility for several years and have never seen any resident being verbally or physically abused. Both R2 and R3 stated that everyone is treated fairly and fed three meals a day.

LPA August obtained medical records for R1. Records indicate that R1 is diagnosed with Schizophrenia and unspecified dementia with behavioral disturbance.

As such, there is insufficient evidence to corroborate whether the above allegation have occurred. With the information obtained through the means described above, we have found the above allegations unsubstantiated. Although the allegations may have happened or may be valid; there is not a preponderance of evidence to prove that the alleged violations occurred. No deficiencies were observed, and no citations were issued during this visit.

An exit interview was conducted with Administrator Randy Mendoza via tele-visit and a copy of this report was provided to Administrator Mendoza via email. Administrator Mendoza to sign all pages of the report and return the signed copy to LPA August via email within 24 hours.

SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: James August
LICENSING EVALUATOR SIGNATURE:	DATE: 05/11/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/11/2021

LIC9099 (FAS) - (06/04)

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